Refractory Macular Hole Surgery: A Review of Recent Surgical Innovations

After the first successful macular hole surgery performed by Kelly and Wendel in 1990, advances in surgical techniques and instrumentation have established pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade as the gold standard for macular hole treatment. Closure rates are widely regarded as over 90% with this approach. In cases of persistent or recurrent full-thickness macular holes (FTMHs), new surgical techniques have been pioneered over the past decade for holes with worse prognosis related to size, chronicity, myopia, prior unsuccessful surgery, or other factors. This review aims to summarize the surgical developments, outcomes, and rationale for 3 techniques: the inverted ILM flap, amniotic membrane grafting, and autologous retinal transplantation.